Provider Demographics
NPI:1700909900
Name:RADIOLOGY CONSULTANTS OF JACKSONVILLE MRI
Entity Type:Organization
Organization Name:RADIOLOGY CONSULTANTS OF JACKSONVILLE MRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GRNJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-929-3400
Mailing Address - Street 1:210 S FEDERAL HWY STE 403
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6811
Mailing Address - Country:US
Mailing Address - Phone:954-929-3400
Mailing Address - Fax:954-929-2001
Practice Address - Street 1:7999 PHILIPS HWY STE 310
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-4404
Practice Address - Country:US
Practice Address - Phone:904-652-0614
Practice Address - Fax:954-929-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME20137261QM1200X, 261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60302Medicare UPIN
FLU5836Medicare ID - Type Unspecified